265. Acute Fulminating Gas Gangrene

Rayburn, James D., Pfc. 34634794 Age 20 H Co 179th Inf.
Injured 1900 hrs. 30 Dec. 44 Own mortar.
2nd Bn Aid Sta 179th Inf. 2030 hrs.   1 unit blood plasma
Coll Co B. 2300 hrs.   500 cc plasma
Clr Co. 120th Med Bn      
57th Field Hosp. 0015 hrs.    

Gen’l condition on admission poor. Shock. B.P. 90/40. Both lower extremities in Thomas splints. Dressings soaked with blood. Left leg from knee distally was cold anesthetic and white. No arterial pulsations could be felt in right foot. Powder burns of face. Perf. wds of cornea bilateral. Vision impaired markedly. Chest clear. Abdomen soft.

Diagnosis: 1) Mine wds., multiple pen and perf thigh and leg, right, sv; 2) Traumatic amp. incomplete foot right; 3) F.C.C. femur, middle third, right, sv; 4) Lac wds scrotum; 5) wd pen hand right.

Preop Rx: B.P. 90/40 0015 hrs. 600 cc plasma. 0100 hrs. 600 cc plasma 0120 hrs. Pulse 0130 hrs. 120. B.P. 118/30 at 0200 hrs. M.S. gr 1/6 @ 0345 hrs. 500 cc blood 0500 hrs. M.S. gr 1/6 0615 hrs. Blood 500 cc 0730 hrs.


1005 hrs. B.P. 140/70 P. 150 Endotracheal E. & O2
1050 hrs. B.P. 120/60 P. 156  
1130 hrs. B.P. 100/40 P. 152 plasma 500 cc
1150 hrs. B.P. Pulseless ~ B.P.   Expired on table!!

Pt’s operation was delayed because of two priority cases (1) Evisceration 2) Buttock wd involving abd.) and because of delay in repeating Xrays. Left thigh middle third guillotine amputation. Left thigh stump further debrided. One missile tract extended from middle third medial aspect of thigh to greater trochanter posterior to femur. Extensive muscle debridement and excision was necessary. Wds. were obviously involved by a fulminating gas bacillus infection. Muscle was beefy, edematous, non-contractile and did not bleed. Had foul odor. Gas bubbled from wounds. Right leg debrided by a second team at same time. There was such destruction of bone and muscle tissue that amputation was considered. Muscle had same appearance as that in left thigh and leg. One hour after start of procedure Pt. suddenly expired. 15 minutes prior to death B.P. was 100/40 P. 150.

(Abd. & chest opened post mortem found grossly neg. Further dissection of left thigh showed extensive involvement of gas process.) Muscle specimin sent to Med Lab for culture.

Jan. 23. Report from Med Lab received. Tissue was positive for gas bacillus.
  Report from 1st Med Lab received 8 Jan. 45.
  Tissue--Clostridium Perfringens (Cl. Welchii)
Clostridium Sordellii (Sordellii-bifermentation group) isolated.
  Blood neg.--10 days.
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